Tseng Tuo-Yen, Mitchell Mary M, Chander Geetanjali, Latkin Carl, Kennedy Caitlin, Borison S Ian, Son Chaeyeon, Knowlton Amy R
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pennsylvania State University, University Park, PA, USA.
AIDS Behav. 2025 Apr 17. doi: 10.1007/s10461-025-04717-8.
Enhancing mental health-related quality of life (MHRQOL) is an important clinical objective for people with HIV (PWH), due to their elevated risk of psychological distress and mental health challenges. Depression, pain, stigma, and discrimination are among the main contributors to poor MHRQOL in this population and can negatively impact PWH's interaction with their healthcare providers, and vice versa. We used structural equation modeling to examine whether the quality of patient-provider engagement in HIV primary care mediated the effects of depression and prior experiences of discrimination in healthcare settings on later MHRQOL, assessed using the SF- 12 Mental Component Summary (MCS- 12), among a sample of predominately African Americans with HIV and a history of drug use. A total of 331 participants, recruited from HIV clinics and community venues in Baltimore, Maryland, USA, completed three semi-annual surveys between 2014 and 2018. At baseline, the sample showed a high percentage of probable depression (35.6%) and a low MCS- 12 mean score (38.72, SD = 6.88) compared with the US general population norm of 50 (SD = 10). There were significant indirect paths from baseline depression (β = - 0.04, 95% CI = - 0.10, - 0.01) and healthcare discrimination (β = - 0.05, 95% CI = - 0.12, - 0.01) to lower MHRQOL at 12-months, mediated through reduced patient-centered patient-provider engagement with primary care providers at 6-months, after adjusting for baseline assessment of the mediator and the outcome, demographic covariates, substance use, pain level, and time since HIV diagnosis. Findings suggest a potential for mitigating the impacts of depression and healthcare discrimination on MHRQOL through intervening on the quality of patient-provider engagement.
提高心理健康相关生活质量（MHRQOL）是艾滋病毒感染者（PWH）的一项重要临床目标，因为他们面临心理困扰和心理健康挑战的风险较高。抑郁、疼痛、耻辱感和歧视是导致该人群MHRQOL较差的主要因素，并且会对PWH与医疗服务提供者的互动产生负面影响，反之亦然。我们使用结构方程模型来检验在以非洲裔美国人为主且有吸毒史的艾滋病毒感染者样本中，HIV初级护理中患者与提供者互动的质量是否介导了抑郁和医疗环境中既往歧视经历对后期MHRQOL的影响，MHRQOL使用SF - 12心理成分总结（MCS - 12）进行评估。总共331名参与者从美国马里兰州巴尔的摩的艾滋病毒诊所和社区场所招募，在2014年至2018年期间完成了三次半年期调查。在基线时，与美国普通人群平均分为50（标准差 = 10）的标准相比，该样本显示出较高比例的可能患有抑郁症（35.6%）以及较低的MCS - 12平均得分（38.72，标准差 = 6.88）。在调整了中介变量和结果变量的基线评估、人口统计学协变量、物质使用情况、疼痛程度以及自艾滋病毒诊断以来的时间后，从基线抑郁（β = - 0.04，95%置信区间 = - 0.10， - 0.01）和医疗歧视（β = - 0.05，95%置信区间 = - 0.12， - 0.01）到12个月时较低的MHRQOL存在显著的间接路径，这是通过6个月时与初级护理提供者的以患者为中心的互动减少来介导的。研究结果表明，通过干预患者与提供者互动的质量，有可能减轻抑郁和医疗歧视对MHRQOL的影响。
